Getting Over the 'Ick' Factor: Colonoscopies Save Lives

NJ doctors say screening is worth a pound of cure as study finds cancer screening cuts death risk in half.

More lives could be saved from colon cancer -- "a preventable, treatable, beatable disease" -- if people could overcome their squeamishness and get a colonoscopy. That's the findings of new research and the message from New Jersey doctors speaking out for colon cancer screening.

But despite the evidence affirming the colonoscopy as a lifesaver, the screening endures an unpleasant and inconvenient reputation, or as one NJ doctor described it, the "ick" factor.

"It is all due to fear of the test, embarrassment, and stories they have heard about how difficult the prep is -- it is really overstated hype," said gastroenterologist Dr. Paul De Martino, who will be in Toms River on Tuesday at the Community Medical Center's Annual Colorectal Cancer Awareness Fair.

De Martino founded the event eight years ago. "My mission is to raise the awareness of the general public about colorectal cancer," he said.

Recommended every 10 years from age 50, a colonoscopy requires patients to prep by taking laxatives to thoroughly clean out the colon, or large intestine. Most patients choose sedation for the procedure, which lasts about a half hour, while a physician inserts a flexible tube with a camera on the tip, and examines the interior of the colon. If polyps are found, the physician usually removes them immediately. If cancer is suspected, tissue is removed for biopsy.

Unlike most diagnostic tests, the colonoscopy delivers both screening and treatment: Removing polyps removes the risk that they might develop into colon cancer.

"This is one of the few cancers we can detect early by finding polyps, which are the forerunners of colon cancer," said Dr. Richard Chessler of Advanced Gastroenterology in Englewood Cliffs.

The life-saving value of the colonoscopy was affirmed by a newly reported study that followed patients for 20 years, and found the death rate cut by 53 percent for patients who had colonoscopies in which doctors removed pre-cancerous polyps. The research, led by a team from Memorial Sloan-Kettering Cancer Center in New York, was published Feb. 23 in the New England Journal of Medicine.

New Jersey requires insurance plans to cover colon cancer screenings, which are also covered by Medicare and Medicaid. In addition to the colonoscopy, other screenings for colorectal cancer include the virtual colonoscopy, in which a radiologist views a CT scan of the interior of the colon; flexible sigmoidoscopy, where a scope is inserted to examine the lower one-third of the colon, and a barium enema. An annual fecal screening is recommended each year to check for blood in the stool.

Thomas Vincz, spokesman for Horizon Blue Cross Blue Shield of New Jersey, said a colonoscopy once every 10 years is a covered benefit for Horizon members. "As with many other forms of cancer and disease, we believe that prevention and early detection are extremely important," Vincz said. "Colorectal cancer is curable if caught in the early stages. We encourage members to talk with their healthcare provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks of each test."

Low-income New Jerseyans can get free colon cancer screenings through a program of the state Health Department, called New Jersey Cancer Education and Early Detection (NJCEED). The program provides education and screening for breast, cervical, colorectal and prostate cancers. For colon cancer screening, NJCEED offers the fecal blood test and the colonoscopy.

In fiscal year 2011, NJCEED provided 3,858 fecal blood screenings and 367 colonoscopies, which led to five colon cancer diagnoses. Individuals eligible for NJCEED services must be at or below 250 percent of the federal poverty level and be either uninsured or under-insured. NJCEED services are delivered statewide by 22 agencies, with at least one in each county, and information is available at 1-800-328-3838.

According to a 2010 estimate from the federal Centers for Disease Control and Prevention, 65.6 percent of New Jerseyans over age 50 have had at least one colonoscopy or sigmoidoscopy. And according to estimates from the state's health department, from 2004 to 2008, colon cancer deaths per 100,000 were 22.6 for New Jersey men, compared to 20.7 for the U.S.; and 16 for New Jersey women compared to 14.5 for the U.S.

Colon cancer deaths are significantly higher for black men. In New Jersey, the rate for black men was 29.9 per 100,000, slightly lower than the U.S. figure of 30.5; and the mortality rate for New Jersey black women was 21 per 100,000, slightly above the U.S. rate of 20.4

The higher mortality rates for colon cancer among African Americans may reflect less screening and early detection, according to Dr. Shawna Hudson, director of community research at The Cancer Institute of New Jersey, and an associate professor of family medicine and community health at UMDNJ-Robert Wood Johnson Medical School.

The inconvenience associated with the colonoscopy is a barrier to wider compliance, Hudson said. The laxative prep begins the night before, and the two-day commitment is tough for those with rigid work schedules who can't easily take time off or who work the night shift.

"For populations who either don't have regular access [to the healthcare system] or don't have the ability to take time off from work, it is very difficult to get that gold standard which is the colonoscopy," Hudson said.

The uninsured are much less likely to seek out a colonoscopy. "It's hard enough to get folks who have health insurance to go through the procedure," said Hudson, who is in her 40s, but because she has a family history of colon cancer, has already had one colonoscopy and is due for another one soon.

Individuals who don't have the ability to pay for healthcare are reluctant to get health screenings, Hudson said. " "The thought is -- if they do find something -- now what?" That, in part, explains the racial disparity in mortality rates for African Americans who are diagnosed with colorectal cancer because they are less likely to go through the chemotherapy treatments, she said.

There is also the challenge of making sure that people who do have access to care actually use that care. "One issue is the 'ick' factor-- people just don't want to deal with colonoscopies or with colon cancer screening. I think we need to get over that," she said.